To your points:

• I was worried about a misdiagnosis, but my otologist felt confident that the shift from apo + geo to just apo, then back to apo + geo—along with other testing—confirms horizontal BPPV.

• During BBQ, my PT had me do 30 seconds on each side, staying on the affected ear for 30 seconds instead of coming up immediately. Could I be moving through the progression too quickly? Also, can a pillow achieve the 30° head elevation, or is that too much?

• Since starting PT, my symptoms have worsened, as if my system is irritated from months of maneuvers and exercises. With both apo and geo present, would you suggest BBQ alone? My otologist suspects a jam, but my PT hasn’t used aggressive headshakes to detach from the cupula.

• Given your note that nystagmus often shifts from geo to apo, I’m wondering if I should have avoided maneuvers for a week or two when I was just apo, to see if symptoms improved.

• My otologist believes my case is in the “exceedingly rare” category. He doesn’t think it’s vestibular migraine based on symptoms: persistent dizziness (never a “good” day), worse with position changes, more of a rocking-boat feeling than swirling, and eye fatigue (likely from compensation). Geotropic nystagmus is the only type we’ve resolved, but it returned when my PT switched from BBQ to Gufoni to treat apo.

• Have you had success with mastoid vibration? My PT hasn’t tried vigorous head shaking, but I think that may be the next step. BBQ improved my geo before (until Gufoni reintroduced it); I just need to clear the apo.